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| * Anyone interested in quick NBME discussion? |
| | #249024 |
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How abt we post qs n follow thru with answers , that way we'll be sure of whatever we choose..... No arguements, just plain this is what i think! U can support ur answer if u want, not if u don't! Anyone???? Right here! |
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| * Re:Anyone interested in quick NBME discussion? |
| #1078979 |
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hi mt ,tanks tanks tanks!!!!!!!!
13. ^ GGT ,so i go for alcohol.but,i'm in doubt....
22. dementia+;rule out a,d,e;either anti cholinesterases for alzeimer's or dopa agonists for parkinson's.
CT - mild vol.loss;[cortical atrophy in alzeimer's]....so,i opted for B anti cholinesterase inhibitors like donepezil.if there is no improvement after 6 months....discontinue them.
23. baby with anasarca,dec.hb ,HSM,coomb's + = hemolysis is going on...some incompatibility.
ABO = milder form ,as IgM can't cross placenta.
Rh = severe.IgG crosses pl.
so,for Rh = mother O neg and baby O pos.
hope u got it.correct me if any mistake is there.... |
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| * Re:Anyone interested in quick NBME discussion? |
| #1078997 |
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24.E i guess
25.B
26.D i'm not sure
27.D reaction to previous blood transfusion
28.E air under diaphragm = perforation =immediate laparotomy
29.D
30.A
31.A i'm poor in this and i guess
32.D atypical pneumonia
33.B ?? panic attacks [first occured while she was crossing a narrow bridge] |
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| * Re:Anyone interested in quick NBME discussion? |
| #1079027 |
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agree with all...
25.DT indicated booster..since coming in 10 yrs ..flu not indicated in 55 yrs old
29.?thyroid replacement for hyperlipidemia.....i think gemfibrozil only after diet n exercise and other causes of hypo ruled out?
plz give input |
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| * Re:Anyone interested in quick NBME discussion? |
| #1079053 |
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25. E, AFTER EVERY 10 YR IS THE RECOMMENDATION, TOO YOUNG FOR INFL. EVEN NOW.
26.C, Li will cause high TFTs not PC.
28. E, i can't bring myself to chose a/d even though they came to mind. He has perotinitis, rush him to OR before he goes into shock.
29) Shouldn't alchol cessation be most approp?
33) B. what abt oxygen though?
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| #1079058 |
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k, last bit then..i'm off.
34. A 67-year-old man is brought to the emergency department 4 hours after the onset of severe midlumbar back pain. He is anxious, pale, and diaphoretic. His temperature is 37.1 C (98.8 F), blood pressure is 105/65 mm Hg, and pulse is 120/min. Examination shows no other abnormalities. X-ray films of the lumbar spine show degenerative disc disease with calcifications anterior to the vertebral bodies. Which of the following is the most likely diagnosis?
A
) Aortoiliac occlusion
B
) Herniated nucleus pulposus
C
) Lumbar discitis
D
) Lumbar strain
E
) Pyelonephritis
F
) Ruptured aortic aneurysm
G
) Spinal stenosis
35. A 17-year-old boy is brought to the emergency department by his parents because of bizarre behavior for 6 hours. Last night he was out with friends, and since returning, he has been confused and has "trashed" his room. His blood pressure is 165/95 mm Hg. He is hypervigilant, has little spontaneous speech, and is disoriented to place and time. He appears catatonic but abruptly becomes assaultive two times and needs to be restrained. Which of the following is the most likely substance taken?
A
) Cocaine
B
) Ecstasy
C
) LSD
D
) Methaqualone
E
) PCP
The response options for the next two items are the same. You will be required to select one answer for each item in the set.
For each patient with back pain, select the most likely diagnosis.
A
) Herniated disc
B
) Lumbar spinal stenosis
C
) Metastatic cancer
D
) Muscle strain
E
) Osteoporotic compression fracture
F
) Sacroiliitis
G
) Spinal epidural abscess
H
) Spondylolisthesis
36. A 57-year-old woman is brought to the physician 2 days after the sudden onset of severe low back pain; the pain does not radiate to the lower extremities. The pain began when she was lifting her grandson. She does not have weakness or sensory loss in the legs and has had no urinary incontinence. She has a 10-year history of rheumatoid arthritis treated with prednisone. Her temperature is 37 C (98.6 F), blood pressure is 130/60 mm Hg, and pulse is 64/min. Examination shows deformities of the interphalangeal joints of the hands and exquisite tenderness to percussion over the lumbar spine. Bilateral straight-leg raising to 80 degrees does not increase the pain. Muscle strength and sensation are intact in the lower extremities. Deep tendon reflexes are 2+ bilaterally. Babinski's sign is absent bilaterally.
For each patient with back pain, select the most likely diagnosis.
A
) Herniated disc
B
) Lumbar spinal stenosis
C
) Metastatic cancer
D
) Muscle strain
E
) Osteoporotic compression fracture
F
) Sacroiliitis
G
) Spinal epidural abscess
H
) Spondylolisthesis
37. A previously healthy 32-year-old plumber comes to the physician because of a 3-week history of constant, dull, low back pain that does not radiate to the extremities. The pain began after he unloaded heavy equipment from his van. It increases with activity and is temporarily relieved by bed rest and ibuprofen. Examination shows tenderness to palpation over the lumbar paraspinal region bilaterally. The pain increases with forward or lateral movements of the spine. Muscle strength and sensation are intact in the lower extremities. Bilateral straight-leg raising to 80 degrees does not increase the pain. Deep tendon reflexes are 2+ bilaterally. Babinski's sign is absent bilaterally.
38. A 72-year-old man comes to the physician because of a 2-month history of urination twice nightly and occasional urinary frequency and urgency. He has a 15-year history of type 2 diabetes mellitus now moderately well controlled with glyburide. His father was diagnosed with prostate cancer at the age of 70 years, and his sister died of complications from systemic lupus erythematosus. His blood pressure is 135/86 mm Hg. Cardiopulmonary examination shows no abnormalities. Abdominal examination shows no suprapubic fullness or tenderness. There is mild enlargement of the prostate with no palpable nodules. His postvoid residual volume is 10 mL. Serum studies show a urea nitrogen (BUN) level of 45 mg/dL and creatinine level of 3.8 mg/dL. Urine dipstick shows 3+ protein. Which of the following is most likely to have prevented progression of this patient's renal disease?
A
) Intermittent Foley catheterization
B
) Intravenous mannitol therapy
C
) Oral cyclophosphamide and prednisone therapy
D
) Oral enalapril therapy
E
) Oral finasteride therapy
F
) Oral prednisone therapy only
G
) Oral terazosin therapy
39. Two hours ago, a 24-year-old man had the sudden onset of pain in the right side of his chest that has become increasingly severe. He is now having difficulty breathing. His temperature, blood pressure, and pulse are normal. An x-ray film of the chest is shown. Which of the following is the most appropriate next step in management?
A
) Bed rest and sedative therapy
B
) Antibiotic therapy
C
) Anticoagulant therapy
D
) Tube thoracostomy
E
) Immediate thoracotomy
40. A 21-year-old college student comes to the physician because of acne that developed 4 days ago while she was taking her medical college admission test. She is concerned about her appearance and plans to be in a wedding in 3 weeks. She has had similar episodes that have resolved completely without treatment. Examination shows acute acne over the face with a predominance of comedones and pustules. There is no evidence of chronic scarring. Which of the following is the most appropriate initial step in treatment?
A
) Dietary restriction of chocolates and simple sugars
B
) Dietary restriction of milk products
C
) Topical acyclovir
D
) Topical hydrocortisone cream
E
) Topical retinoic acid
41. A 67-year-old woman comes for a routine health maintenance examination. She exercises regularly. She is not sexually active. At her last visit 1 year ago, her serum cholesterol level was 180 mg/dL, and fasting serum glucose level was 80 mg/dL; a Pap smear and mammography showed normal findings. Two years ago, flexible sigmoidoscopy showed no abnormalities. Today, she weighs 63 kg (140 lb) and is 165 cm (65 in) tall. Her blood pressure is 120/80 mm Hg. Examination shows no abnormalities. Which of the following is the most appropriate screening test for this patient?
A
) Pap smear
B
) Measurement of serum cholesterol level
C
) Measurement of serum glucose level
D
) Mammography
E
) Flexible sigmoidoscopy
42. A 62-year-old man has had the gradual onset of fatigue and shortness of breath over the past 3 years. There is striking jugular venous distention with a large wave occurring with S2. The carotid upstroke is normal. Cardiac examination shows a lifting systolic motion of the sternum and no palpable point of maximal impulse. A grade 3/6, holosystolic, plateau-shaped murmur that is loudest on inspiration is heard at the lower left sternal border. The liver is enlarged and tender, and the abdomen is swollen with a fluid wave. There is marked ankle edema. Which of the following is the most likely cause of the murmur?
A
) Aortic stenosis
B
) Mitral regurgitation
C
) Mitral stenosis
D
) Tricuspid regurgitation
E
) Ventricular septal defect
43. A 24-year-old woman comes to the physician because of constant, severe pain in her neck, shoulders, and back for 3 months. She has been unable to enjoy her usual activities because of the pain. Use of over-the-counter ibuprofen and aspirin has not relieved her symptoms. She has a history of irritable bowel syndrome. Examination shows multiple tender spots over the neck, shoulders, and lumbar spine. Range of motion of all joints is full. There is no evidence of synovitis. Fluorescent serum antinuclear antibody and rheumatoid factor assays are negative. Which of the following is the most likely diagnosis?
A
) Ankylosing spondylitis
B
) Fibromyalgia
C
) Polymyalgia rheumatica
D
) Polymyositis
E
) Seronegative rheumatoid arthritis
44. A 72-year-old man comes to the physician because of a 6-month history of mild to moderate shortness of breath when climbing stairs. He had a myocardial infarction 2 years ago and has had an ejection fraction of 35% since then. His only medication is a β-adrenergic blocking agent. The lungs are clear to auscultation. Cardiac examination shows an S4 gallop. There is no peripheral edema. Laboratory studies are within normal limits. An ECG shows no acute changes. Which of the following is the most appropriate pharmacotherapy?
A
) α-Adrenergic blocking agent
B
) Angiotensin-converting enzyme (ACE) inhibitor
C
) Angiotensin2-receptor blocking agent
D
) Nitrates
E
) Thiazide diuretic
45. A 42-year-old woman comes to the physician because of a 3-month history of a recurrent vivid dream that several men are assaulting her and her children. Upon awakening, she is anxious and distressed by the frightening images. She realizes that it is just a dream but is afraid to go back to sleep. She does not know why she is having this particular dream because she has never been the victim of an assault. She drinks two to three cups of coffee each morning. She does not use illicit drugs. Physical examination shows no abnormalities. There is no evidence of depressed mood or hallucinations. Laboratory studies are within normal limits. Which of the following is the most likely diagnosis?
A
) Acute stress disorder
B
) Nightmare disorder
C
) Panic disorder
D
) Sleep apnea
E
) Sleep terror disorder
46. A 57-year-old man is brought to the emergency department 30 minutes after he was found on the floor of his house; he has left hip pain and shortness of breath. He has renal failure but has missed his last two dialysis treatments. His renal failure was caused by inadvertent ingestion of ethylene glycol. His renal function did not improve, and he is currently on the transplantation list. Medications include amlodipine and doxazosin. On arrival, his temperature is 37.5 C (99.5 F), blood pressure is 150/100 mm Hg, pulse is 95/min and regular, and respirations are 24/min. His breathing is rapid and deep. Crackles are heard in the lung bases. Examination shows a soft abdomen. Bowel sounds are normal. The left lower extremity is externally rotated. Laboratory studies show:
Serum
Na+ 135 mEq/L
Cl– 102 mEq/L
K+ 7.1 mEq/L
HCO3– 12 mEq/L
Arterial blood gas analysis on 4 L/min of oxygen by nasal cannula:
pH 7.22
PCO2 31 mm Hg
PO2 61 mm Hg
An ECG shows peaked T-waves. It will be at least 45 minutes before dialysis can be started. Which of the following is the most appropriate next step in management?
A
) Observation until dialysis is initiated
B
) Intravenous calcium gluconate
C
) Intravenous glucose and insulin
D
) Intravenous 0.9% saline
E
) Intravenous sodium bicarbonate
F
) Rectal sodium polystyrene sulfonate (Kayexalate
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